West Virginia Medicare Savings Program Income Limits 2026

2026 Income Limits by MSP Tier

West Virginia runs three Medicare Savings Programs through the Department of Human Services, each with its own income ceiling tied to the Federal Poverty Level. All three use the same resource limits.

QMB (Qualified Medicare Beneficiary) — up to 100% FPL:

• Single: $1,350/month
• Couple: $1,824/month
• Covers Part A and B premiums, deductibles, coinsurance, and copays

SLMB (Specified Low-Income Medicare Beneficiary) — 101–120% FPL:

• Single: $1,351–$1,616/month
• Couple: $1,825–$2,184/month
• Covers Part B premium only

QI (Qualifying Individual) — 121–135% FPL:

• Single: $1,617–$1,816/month
• Couple: $2,185–$2,455/month
• Covers Part B premium only (funded through a capped federal grant, first-come basis)

These figures already include the $20 general income disregard that caseworkers subtract automatically.

Resource Limits: the Number That Catches People Off Guard

All three tiers share the same 2026 resource limits: $9,950 for an individual and $14,910 for a couple. Countable resources include checking and savings accounts, CDs, stocks, bonds, and non-exempt real property.

A warning about outdated state pages: some older West Virginia documents still show $4,000/$6,000 resource limits. Those figures are wrong. Federal standards updated the thresholds years ago, and SSA POMS HI 00815.023 confirms the current numbers. Apply based on the federal figures, not legacy state web pages.

Your primary home is excluded up to the $752,000 equity limit, one vehicle is excluded regardless of value, and burial plots and irrevocable prepaid burial contracts are excluded from the resource count. Life insurance policies with a combined face value under $1,500 per person are also excluded.

How Caseworkers Calculate Countable Income

West Virginia uses non-MAGI rules under the Income Maintenance Manual — not the tax-based MAGI methodology used for marketplace coverage. The calculation works like this:

1. Start with all gross unearned income: Social Security, SSDI, pensions, VA benefits, annuities
2. Subtract the $20 general income disregard
3. For earned income: apply any unused portion of the $20 disregard, subtract the first $65, then halve the remainder

That $20 disregard is why the QMB limit is listed as $1,350 rather than the raw 100% FPL figure of $1,330. The disregard effectively raises the qualifying income ceiling.

One detail that trips families up: an adult child's income does not count toward a parent's eligibility, even if they live in the same household. Non-MAGI rules exclude adult children entirely from the assistance group.

When One Spouse Qualifies but the Other Doesn't

If a married couple lives together, caseworkers combine both spouses' income and resources and compare against the couple thresholds — regardless of whether both spouses have Medicare. If only one spouse applies, the couple still uses couple limits.

If spouses are legally separated or living apart with no shared finances, the applicant is evaluated as an individual using single-person limits.

What Happens If You're Just Over the Line

Missing QMB by a few dollars doesn't mean you're out of options. SLMB catches people between 100% and 120% FPL, and QI extends that to 135%. Even at the QI ceiling, the state pays your entire $202.90/month Part B premium — that's $2,434.80 a year back in your pocket.

All three tiers also trigger automatic eligibility for Extra Help with Part D prescription drug costs, capping generic copays at $5.10 and brand-name copays at $12.65 per fill.

If your income fluctuates month to month (seasonal work, irregular pension payments), caseworkers average it over a representative period. A lump-sum payment is evaluated under resource rules in the month after receipt. Report a change to DoHS within 10 calendar days.

Get the complete West Virginia Medicare Savings Programs guide for income worksheets, worked examples at each tier, and a step-by-step application walkthrough.

See more West Virginia guides →